Provider Demographics
NPI:1447309778
Name:KHAN, ZEINUR (OD)
Entity type:Individual
Prefix:DR
First Name:ZEINUR
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ZEINUR
Other - Middle Name:
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:40 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1913
Mailing Address - Country:US
Mailing Address - Phone:617-932-1830
Mailing Address - Fax:
Practice Address - Street 1:1125 TREMONT ST
Practice Address - Street 2:
Practice Address - City:ROXBURY CROSSING
Practice Address - State:MA
Practice Address - Zip Code:02120-2178
Practice Address - Country:US
Practice Address - Phone:617-989-3126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4597152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU85710Medicare UPIN
ILL86651Medicare ID - Type Unspecified